“Abnegation of Trust”

Tuesday, February 5th, 2013

Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.
:
Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”

Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors. [emphasis mine]

Good old New York Times. Even in cases where they report on something of value, that the public really does need to understand better, they stick to the same old script: Look at this one case that’s guaranteed to grab your attention! Now, very few of them are like that, but what really is a widespread problem, is this other thing over here…so you have to ask the question…why did you select this case study for your story, if it isn’t representative of the phenomenon you want to discuss? Aw well. To sell newspapers of course, silly.

So we have a bit of extra work to do. We have to read the story front to back and say, what was the problem here? And the answer is not Adderall patients hanging themselves. The issue is time.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

That “segment of doctors” link takes you to another New York Times article from a few months ago. Let’s click that puppy open. Because that’s where the important stuff is:

When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall.

The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.

“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.

It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed. [emphasis mine]

I wonder how the NYT would account for the huge spike in Adderall (and related uppers) usage among middle class kids (as the poor fellow who hung himself in the former article seemed to be).

I love advocacy journalism.

Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools…. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Let’s see if we can count the stolen bases here:

1) “Inadequate schools.” Because that’s surely been my experience. Your kid is zoned for a rotten school, so you… head to the psych clinic. Makes sense. Hey, I’ve got an idea: President Obama is always going on about how green tech and whatnot is going to save America’s economy. Why don’t we pump every engineering student in the country full of Adderall? If Dr. Anderson is right and it’s a mechanistic effect — “normal kid” + “poor school” + “Adderall” = “Stand and Deliver” — then shouldn’t it work twice as well on motivated kids in great schools? Dope up every MechE at Harvey Mudd, and we’ll have Solyndra up and running in no time. Oh, wait:

“some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.

So they’re already shooting up at Cal Tech, but it’s “not yet clear” if Dr. Anderson represents anything other than a name to put to “some experts'” opinions.

2) “We’ve decided as a society.” Who is this “we,” kemo sabe? I don’t remember getting a vote on this. More importantly: ““We’ve decided as a society that it’s too expensive to modify the kid’s environment.” I call bullshit on this. I vote for police pay raises every chance I get. You really want to up the kids’ academic performance? Then realize how hard it is to learn when you spend most of your time worried about getting shanked in study hall. But, of course, that’s not what “modify the kid’s environment” means.

3) “They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.” By this point, even junior high kids in the the most cash-strapped schools can point to a jillion studies exploring the link between per-pupil spending (ours is among the highest in the world) and academic performance (ours is pretty good until high school, where the PC bullshit really kicks in). There isn’t any. The best, because funniest, example is the Washington, DC, school system, which has some of the highest per-pupil spending in the nation, yet is an educational cesspit. Which is why, of course, Our Betters in the government send their kids to Sidwell Friends.

It figures that the Times would be twenty years behind them. Diagnoses get trendy and suddenly take a jump as public awareness is “raised” to a problem. It runs almost in a cycle:

1. genuine problem
2. new or rediscovered treatment proves effective
3. sudden spike in problem as people try said treatment on difficult cases
4. “raise awareness”
5. further spike in diagnosis of problem
6. new genuine problem – the over-diagnosis and over-medication of old problem

It’s happened with autism, it’s happened with ADHD, and neither of these things is new news. I’ve had this running argument with a schoolteacher friend for years now. “You don’t understand how these medicines truly help these kids,” she’ll say, and I’ll reply, “I do understand, but that doesn’t mean that every kid getting this stuff actually has ADHD or some other disorder.” To which the reply is, “You don’t understand.” Sigh.

In short, it’s easier to throw a pill at a problem than to solve it, much less figure out exactly what the problem is. Half these kids are really only guilty of being kids.

And at least half of the other half are only guilty of being high achievers.

Wiki says Adderall has been around since 1996 — too late for my college years — but back when I was a lowly undergraduate, architecture, engineering, and law students popped Ritalin and dexys like candy. Gives you twice the zap of caffiene, I’m told, so long as you’re prepared for the crash….

I surely would like to know how this, at least, is “society’s” problem. I never met an engineer or architect who didn’t really, truly want to be one; that’s why they have those weed-out courses freshman year. It’s entirely possible to do both those majors without greenies — all my friends did — but the ones who do pop them tend to not be, shall we say, over-concerned with “society’s” standards.

The leftist would reply that this is yet another case of kids internalizing capitalist social discipline — they want to want to pop greenies in order to be better little producers for the corporatist state — but given that the “my kid does too have ADHD!” crowd tend to be overwhelmingly liberal…..